Today
~How is it, I wonder, that the universe we know to be cold, dark, and dangerous
drapes itself around us in shades of baby blue?~
The motivating principle behind the practice of narrative medicine is the conviction that, in clinical medicine, storytelling is a healing practice. The concept of training health care professionals in narrative medicine originated under the direction of Rita Charon, M.D. at Columbia University. She recognized the fact that patients need to be encouraged to tell their whole story in order for the clinician to come to an accurate diagnosis and to develop an effective treatment plan. A complete medical history reveals not just what symptoms patients are experiencing, but how their illness affects them emotionally, how it impacts the people they love and care for, what fears they harbor, and what expectations they hold.
"Everyone has a story that
will break your heart.
And, if you're really paying attention,
most people have a story
that will bring you to your knees."
~Brene Brown~
hey learned the skills necessary to elicit and interpret the patient's history, to pick-up on missing details, and to understand the patient's illness in the context of his life and community. As a result, patients under their care felt as if someone was finally listening to them. That someone cared. When they felt heard, they did better. They coped more effectively. They were more receptive to therapeutic intervention.
Did they heal because of it? That, of course, depends upon how you define healing.
"Your pain will transform you.
Your story will enliven the world.
Your truths will magnetize your tribe."
~Tanya Markul~
The motivating principle behind the practice of narrative medicine is the conviction that, in clinical medicine, storytelling is a healing practice. The concept of training health care professionals in narrative medicine originated under the direction of Rita Charon, M.D. at Columbia University. She recognized the fact that patients need to be encouraged to tell their whole story in order for the clinician to come to an accurate diagnosis and to develop an effective treatment plan. A complete medical history reveals not just what symptoms patients are experiencing, but how their illness affects them emotionally, how it impacts the people they love and care for, what fears they harbor, and what expectations they hold.
It might be a stretch to say that a narrative approach to patient care speeds wound closure or prevents the spread of cancer. Antibiotics are probably a better choice for pneumonia. You need surgery if you have appendicitis.
Nevertheless, the empathetic connection that develops between the physician and the patient when the patient is heard in a caring, receptive and holistic manner can improve his prognosis.
No illness is free of emotional fallout. Fear. Shame. Anger. Heartache...none of which the patient may want to admit or express. These feelings may, however, be the most amenable to the healing power of storytelling in the clinical setting. Only if the patient is encouraged to express his frustration, fear, and sense of loss can we know what kind of support he needs. Perhaps he simply needs facts to help him understand and embrace his treatment plan. Maybe he needs constant reassurance and encouragement. Maybe she needs assistance arranging for help at home. Some patients welcome prayer at the bedside. Others may not.
We can't know what the patient needs unless we ask. Then, it is up to us to respond empathetically.
"It is more important to know
what sort of person has a disease
than to know what sort of disease
a person has."
~Hippocrates~
For those of us involved in patient care, the operative word is "care." This involves more than tending to the tasks required to treat our patients. It means caring about them. Caring enough to frame the impact of their illness on their emotional and psychological wellbeing, and its impact on their family and friends. On their futures. On their souls. All the hidden places pain lingers.
"Cure sometimes.
Relieve often.
Comfort always."
~Hippocrates~
jan
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